Does Psychological Safety Impact Learning Environments among Rheumatology Fellows: Findings from Veterans Affairs Learners’ Perception Survey
Gamboa JR, Torralba KD, Nguyen CN, Cannon GW, Baz S, Kashner TM
Background/Purpose .
Each year, over 35% of all U.S. residents will rotate through a U.S. Department of Veterans Affairs (VA) medical center as part of their clinical training. The VA Learners’ Perceptions Survey (LPS) was created to assess VA’s performance in furthering its professional education training mission.
Objective.
The purpose of our research is to assess how Rheumatology fellows rate psychological safety (PS) and their experiences with VA faculty/preceptor, along with clinical, learning, working, and personal environments.
Methods .
The LPS is a validated instrument that measures health professions trainee satisfaction with clinical programs. We explored data from 70 Rheumatology fellows who responded to the LPS from July 2011 to January 2014 at 29 VA medical centers across the US. PS was assessed on a 5-point Likert scale (“strongly agree,” “agree,” “neither,” “disagree,” and “strongly disagree”) with: “members of the clinical team of which I was a part are able to bring up problems and tough issues.” This question accounted for 85% of the cumulative variance with other question formats: “I feel free to question decisions or actions of those with more authority,” and “It is safe to take a risk on this clinical team.”
Results .
There were 44 (67%) of 66 respondents who were female, 36 (52%) of 69 were international medical school graduates, 37 (53%) of 70 were PGY 4. Among all 70 fellows, 66 (94%) reported satisfaction with their clinical learning environment, 65 (93%) with preceptors, and 64 (91%) with working, 65 (93%) personal, 66 (94%) clinical, and 61 (87%) medical systems environments. Of the 70 fellows, 67 (96%) agreed or strongly agreed that members of the fellow’s clinical team could bring up problems and tough issues. Among those strongly agreeing their VA experience was psychologically safe, 35(79%) of 45 also rated being very satisfied with their clinical learning (versus 8 (32%) of 25 otherwise, x2(4)=16.272 p=.003); 35 (80%) of 44 with the preceptors (versus 31% otherwise, x2(4)=20.089 p<.001); 36 (84%) of 43 with working (versus 26%, x2(4)=24.364 p<.001), 38 (81%) of 47 personal (versus 21%, x2(4)=22.993 p<.001), 36 (82%) of 44 clinical environment (versus 27%, x2(3)=21.145 p<.001), and 36 (84%) of 43 medical systems (versus 20%, x2(3)=27.044 p<.001.
Conclusion . Our data suggests that Rheumatology fellows were satisfied with their VA clinical learning experience, and that psychological safety was strongly associated with the fellow’s satisfaction of their VA learning, working, and clinical training environments.
Table 1. Overall ratings at VA facility by Rheumatology fellows 2001-2014 across major domains in LPS survey.
|
|
Very Satisfied |
Somewhat satisfied |
Not Satisfied |
|
|||
|
Domain |
Total N |
N (%) strongly psychologically safe |
Total N |
N (%) strongly psychologically safe |
Total N |
N (%) strongly psychologically safe |
x2 |
|
Learning environment |
45 |
35(78%) |
21 |
8 (38%) |
4 |
0 (0%) |
x2(4)=16.3, p=0.003
|
|
Preceptors |
44 |
35 (80%) |
21 |
7 (33%) |
5 |
1 (20%) |
x2(4)=20.1, p<.001 |
|
Clinical environment |
44 |
36(82%) |
22 |
6 (27%) |
4 |
4 (33%) |
x2(3)=21.145, p=0.000 |
|
Physical environment |
37 |
32(87%) |
28 |
11(39%) |
4 |
0 (0%) |
x2(2)=22.144, p=0.000 |
|
Working environment |
43 |
36(84%) |
21 |
6(29%) |
6 |
1 (17%) |
x2(4)=24.364, p=0.000 |
|
Personal experience |
47 |
28(81%) |
18 |
4(22%) |
5 |
1 (20%) |
x2(3)=22.993, p=0.000 |
|
Timeliness of staff and services |
40 |
35(88%) |
24 |
7(29%) |
6 |
1 (17%) |
x2(4)=27.443, p=0.000 |
|
Quality of staff and services
|
41 |
31(85%) |
28 |
8(29%) |
1 |
0 (0.0%) |
x2 (2)=24.266, p=0.000 |
|
System and process in dealing with medical errors |
43 |
36(84%) |
18 |
4(22%) |
7 |
1 (14%) |
x2 (3)=27.044, p=0.000 |
Disclosure:
J. Gamboa,
None;
K. M. D. Torralba,
None;
C. Nguyen,
None;
G. W. Cannon,
None;
S. Baz,
None;
T. M. Kashner,
None.
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